Characterization of the US Food and Drug Administration Post-Marketing Commitments and Requirements for Pregnancy and Lactation.

Enactment of the Food and Drug Administration Amendments Act (FDAAA) in 2007 and the Pregnancy and Lactation Labeling Rule (PLLR) in 2015 are important milestones giving the FDA the authority to request studies in pregnant and lactating women. Our objective was to characterize trends in pregnancy and lactation related post-marketing commitments (PMCs) and post-marketing requirements (PMRs) for new molecular entities approved by the FDA between 2000-2022. Approval letters of original New Drug Applications (NDAs) for new molecular entities were obtained from the FDA website. NDAs (N=488) with pregnancy and lactation-based PMCs/PMRs were identified, and data extracted. Data included: PMC/PMR timelines and attributes of requested study(ies) [type, design elements, and outcomes] when available. Fifty-nine NDAs included 92 PMCs/PMRs related to pregnancy and lactation. Forty-one NDAs had pregnancy related PMRs/PMCs, 4 lactation related PMRs, and 14 both. Most PMRs/PMCs were for nervous system medications (N=33). Forty-seven NDAs specified safety data collection in infants in at least the first year of life. All pregnancy related PMRs were issued after 2008, most PMCs (N=8) were issued before 2008. Only one PMC requested a pharmacokinetic study in pregnant women. All lactation related PMRs (N=18) requested measurement of drug concentrations in breast milk with one also requiring measurement of maternal blood concentrations. 89% lactation related PMRs were requested after 2017. There was a steady increase in pregnancy and lactation related PMRs/PMCs following enactment of FDAAA and PLLR. Additions involvesd information collection pertaining to safety of the medication in pregnant and lactating women and children exposed to medications during pregnancy and breastfeeding.